Elsevier

Gynecologic Oncology

Volume 139, Issue 2, November 2015, Pages 306-311
Gynecologic Oncology

Effects of surgical volumes on the survival of endometrial carcinoma

https://doi.org/10.1016/j.ygyno.2015.09.003Get rights and content

Highlights

  • This study showed no relation between surgical volumes and survival of endometrial cancer.

  • At this moment there is insufficient evidence that concentration of care for women with endometrial cancer leads to improved survival.

ABSTRACT

Objective

This study aims to assess whether surgical volume is related to survival among women with endometrial carcinoma.

Methods

For this population-based retrospective study, all women diagnosed with endometrial carcinoma between January 2005 and December 2010 were included as registered in the Netherlands Cancer Registry. Hospitals were divided into type of hospital: small general, large general, and oncological referral hospitals and into surgical volume: low (< 15/year), medium (15–24/year) and high (≥ 25/year) volume hospitals depending on the average annual number of surgeries for endometrial carcinoma during the study period. Primary outcome was relative survival related to hospital volume.

Results

Of 9133 women, 2596 (24.4%) were surgically treated in low volume hospitals, 3530 (38.7%) in medium volume hospitals and 3007 (32.9%) in high volume hospitals. In the Netherlands, low risk endometrial cancer is typically treated with simple hysterectomy and bilateral salpingo-oophorectomy whilst lymphadenectomy is only performed in high-risk endometrial cancer. Hospitals with high volumes treated relatively more women with high-risk and advanced stage tumors. After corrections for age, stage, histology, grade and type of hospital, no differences in relative survival were found by hospital volume in the total group or in the women with high-risk endometrial cancer, nor in women treated with complex surgery for endometrial cancer.

Conclusions

In this large population based study, no relation between surgical volumes and relative survival of endometrial cancer was observed. Based on this study, we conclude that at this moment there is insufficient evidence that concentration of care for women with endometrial cancer would lead to improved survival.

Section snippets

1. Introduction

Endometrial carcinoma is the most common gynecological malignancy with an incidence of 82,500 newly diagnosed women and 21,700 disease specific deaths per year in Europe [1]. Due to a relatively early detection and good prognosis of early stage disease, the mortality rate is relatively low. Bokhman et al. classified endometrial cancer into two groups: Type 1 endometrioid endometrial carcinoma (EEC), the most common, is considered to be hormone-dependent and has a relatively good prognosis,

2.1. Design and patients

In this population-based retrospective study, all women diagnosed with endometrial carcinoma between January 2005 and December 2010 in The Netherlands were selected. Only women who were surgically treated were included. Of all registered corpus uteri malignancies, we included endometrioid-type, clear cell-type, serous-type and mixed-type endometrial carcinomas (appendix), since these types contribute to over 98% of endometrial carcinomas. All other types of endometrial carcinomas were excluded

3.1. Patients and hospitals

Between January 1st 2005 and December 31st 2010, 10,554 patients were diagnosed with endometrial carcinomas in the Netherlands. Of these women, 689 received non-surgical treatment for endometrial carcinoma, such as radiotherapy, chemotherapy, hormone therapy or a combination of these treatment modalities. Of 732 women, data were missing regarding hospital of treatment; these women were therefore excluded from analyses (Fig. 1). Of the remaining 9133 women, 2596 (24.4%) women were treated in 42

4. Discussion

In this large population based study, no association was observed between surgical volumes and the relative survival of women that were surgically treated for endometrial carcinoma.

Although we expected to find an improved relative survival among hospitals with higher surgical volumes, especially for the high-risk endometrial carcinomas and the complex surgical treatment of endometrial carcinomas, no such difference was found.

To fully understand the impact of our findings, it is important to

Conflicts of interest

All authors declare not to have any financial, personal or other conflicts of interests.

Acknowledgements

We acknowledge the Dutch Comprehensive Cancer Organization and the Netherlands Cancer Registry for the use of their data collection and interpretation.

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